title: Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study.
abstract: OBJECTIVE
  Hepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase-associated lipocalin (NGAL) is a troponin-like biomarker for human acute kidney injury. We aimed to investigate levels of plasma and urine NGAL in HRS and predictive ability of these markers for all-cause mortality, in HRS, stable cirrhosis and control subjects.
  
  
  METHODS
  A total of 64 patients with cirrhosis (8 patients with type 1 HRS, 22 with type 2 HRS, and 34 without HRS) and 23 control subjects were included in the study. Blood and urine samples were measured with Human NGAL sandwich ELISA. Patients were followed up prospectively.
  
  
  RESULTS
  Patients with type 1 and type 2 HRS had significantly higher plasma and urine NGAL levels compared with stable cirrhosis and control subjects. Cox regression analysis showed that plasma NGAL and MELD-Na scores were independent predictors of mortality. ROC-curve analysis showed that the plot of the plasma NGAL, urine NGAL, MELD-Na and Child-Turcot-Pugh score could predict all-cause mortality in cirrhotic patients' area under the curve (AUC 0.819, 0.686, 0.807 and 0.795 respectively).
  
  
  CONCLUSIONS
  NGAL could predict mortality in patients with HRS independent of other commonly used risk factors.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Meram School of Medicine, Konya University, Meram, Konya, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Gungor
authors.forename: Huseyin
authors.initials: H
authors.lastname: Ataseven
authors.forename: Ali
authors.initials: A
authors.lastname: Demir
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Solak
authors.forename: Abduzhappar
authors.initials: A
authors.lastname: Gaipov
authors.forename: Murat
authors.initials: M
authors.lastname: Biyik
authors.forename: Bahadir
authors.initials: B
authors.lastname: Ozturk
authors.forename: Ilker
authors.initials: I
authors.lastname: Polat
authors.forename: Aysel
authors.initials: A
authors.lastname: Kiyici
authors.forename: Ozlem O
authors.initials: OO
authors.lastname: Cakir
authors.forename: Hakki
authors.initials: H
authors.lastname: Polat
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006530:Hepatorenal Syndrome / Q000097:blood / Q000201:enzymology* / Q000401:mortality* / Q000652:urine; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: acute kidney injury; cirrhosis; hepatorenal syndrome; mortality; neutrophil gelatinase-associated lipocalin